Dec 26, 2008

World- China makes medicare more affordable

Gong Yidong

BEIJING: Going to see the doctor was too expensive for 54-year-old peasant Song Zhiyao, but the introduction of a rural cooperative medicine scheme in 2007 has greatly eased his financial burden. A new public-health reform under review might give even more relief to him and millions of others who have been bearing their medical bills for as long as two decades.

Mr. Song lived in Xijiang Village, Kaili City, southwest Guizhou Province for half a century, and misses the days of barefoot doctors before the 1980s. “The villagers only paid a little money for the medical service at the doctor’s small clinic, as the costs were basically covered by the state,” he says. Though the young doctor could only handle injections or minor illnesses like coughs, Mr. Song was largely satisfied. It was a time when China prided itself on a government sponsored medicine system, in which most Chinese enjoyed low-priced medical services.

The good news came in the spring of 2007, when he was notified of a new rural cooperative medical scheme. Under the programme, Mr. Song pays 10 yuan per year, and the government contributes another 10 yuan. If hospitalised, up to 80 per cent of the expenditure can be reimbursed.

In spite of the improved benefits experienced, the medical care system has long been criticised. The focus is on the soaring medical fees, lack of access to affordable medical services, poor doctor-patient relationships and low medical insurance coverage.

In 1997, the State Council issued a historic decision, defining medicine as a social welfare sector. In the next 10 years, China implemented a series of medical reforms, such as the basic medical insurance for urban employees and the new cooperative medical scheme for farmers.

But the Development Research Center of the State Council, an influential think-tank, concluded in a report in 2005 that “the medical reform in the past decade is basically unsuccessful”. In October this year, the long-awaited health care reform plan was released for public debate. A main target is to set up a health care system that covers all urban and rural residents by 2020. The new plan defines government’s responsibility by saying it plays a dominant role in providing public health and basic medical service. The plan also promises to tighten government control over medical fees in public hospitals and to set up a “basic medicine system” to quell public complaints about rising drug costs.

Different from the past when the policy was solely made by the authorities, the central government entrusted nine domestic and overseas organisations to conduct independent research, including the World Health Organization and Mckinsey Company, whose ideas were incorporated into the draft.

In just one month, the draft received 35,000 pieces of advice. But it triggered a heated debate.

An online survey by Sohu, a major portal site, finds that as many as 87.83 per cent were unsatisfied or could hardly understand the 10,000-word document, a compromised product of experts and officials involving 16 departments.

Observers are more concerned over the plan’s effectiveness. For the Guizhou farmer Song, however, the effect of the plan will be felt in years ahead. “My only hope is that I will not be tormented by serious illness any more.” — Xinhua